Placido Romeo

Removal of an intracardiac lost port-A catheter utilizing a simple low-cost method

a Radiologia Ospedale San Vincenzo Taormina (Me) Azienda Sanitaria Provinciale di Messina, Contrada Sirina, 98039 Taormina (Messina), Italy b Cardiologia Ospedale San Vincenzo Taormina (Me) Azienda Sanitaria Provinciale di Messina, Contrada Sirina, 98039 Taormina (Messina), Italy c UOC Oncologia Ospedale San Vincenzo Taormina (Me) Azienda Sanitaria Provinciale di Messina, Contrada Sirina, 98039 Taormina (Messina), Italy

Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases: A case series study:

Background. Venous thromboembolism (VTE) and brain metastases (MTS) are significant clinical problems in the cancer patient population. Brain MTS and deep vein thrombosis are life-threatening conditions because of the risk of fatal endocranic hypertension and pulmonary embolism. Low molecular weight heparin (LMWH) is a major treatment for cancer patients suffering from VTE with regard to the management of the acute phase and subsequent secondary prophylaxis. Treatment with anticoagulants is feared because of the risk of triggering a massive intracranial hemorrhage. Methods. The medical records of patients with hypercoagulability-related complications and carrying brain MTS treated with LMWH, in a 10-year period, were scrutinized. The authors aimed to focus on the occurrence of intracranial hemorrhage in anticoagulated patients; furthermore, data were collected with regard to the characteristics of the administered LMWHs along with the duration and dosing of the anticoagulative treatment. Results. A total of 38 patients (pts) carrying an intracranial metastatic tumor were administered LMWHs: calcium nadroparin (32 pts); enoxaparin (2 pts); reviparin (2 pts); parnaparin (2 pts). Reason for LMWH therapy: deep vein thrombosis and/or pulmonary embolism (15 pts); superficial thrombophlebitis (15 pts); intracardiac thrombus (1 pt); mild DIC (5 pts); acute DIC (1 pt); Raynaud phenomenon (1 pt); atrial fibrillation (1 pt). Median duration of LMWH therapy: 13 weeks (range 1–52). None of the patients developed clinical and/or radiographic findings imputable to intracranial hemorrhage. Conclusion. There is no standard medical approach for the management of patients who require anticoagulant treatment and are suffering from brain MTS. These patients as necessary, might be anticoagulated with LMWH and its dose reduction is to be considered.

Acromegaly Is More Severe in Patients With AHR or AIP Gene Variants Living in Highly Polluted Areas.

CONTEXT An increased prevalence of acromegaly was found some years ago in a highly polluted area in North-Eastern Sicily, where high concentration of nonmethane hydrocarbons, volatile organic compounds, and cadmium was found. Aryl hydrocarbon receptor (AHR) pathway has a key role in detoxification of these compounds and in tumorigenesis. OBJECTIVE We correlated the occurrence of AHR and/or AHR-interacting protein (AIP) gene variants with acromegaly severity according to pollution exposition. DESIGN, SETTING, and PATIENTS This was an observational, perspective study conducted over 7 years in four Italian referral centers for pituitary diseases in which 210 patients with acromegaly were enrolled between 2008 and 2015. INTERVENTION Genetic screening of patients for AHR and AIP variants. MAIN OUTCOME MEASURES Clinical, biochemical, and radiological data of patients with and without AIP and/or AHR gene variants, living in polluted (high-risk for health, [HR]) or nonpolluted (NP) areas of five Italian regions were evaluated and compared. RESULTS Among the 23 patients from HR areas, nine showed AHR or AIP variants. Mean IGF-I levels and pituitary tumor diameter were significantly higher in these nine patients (HR/VAR+) than in the other 14 (HR/VAR−) and in the 187 from NP areas (44 NP/VAR+). Somatostatin analogs significantly decreased mean GH and IGF-I levels in patients from NP areas and in HR/VAR− (GH P < .05; IGF-I times the upper limit of normal P < .01) but not in HR/VAR+ group. CONCLUSIONS Genetic variants potentially inducing functional abnormalities of the aryl hydrocarbon receptor (AHR) pathway are associated with a more severe acromegaly, increased pituitary tumor size, and somatostatin analog resistance in patients living in HR areas.

Transvenous recovery of an intracardiac fractured port-A catheter fragment

a Cardiologia Ospedale San Vincenzo— Taormina (Me), Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy b Radiologia Ospedale San Vincenzo — Taormina (Me), Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy c UOC Oncologia Presidio di Caltagirone, Azienda Sanitaria Provinciale di Catania, Italy d Cardiologia Presidio Ospedaliero “G. Fogliani” — Milazzo (ME), Azienda Sanitaria Provinciale di Messina, Italy

Radiologic team performance index: A new paradigm in KPI evaluating radiology examination volumes department performance: Results of Sicilian regional healthcare system survey

ABSTRACT Background: Efficient management of Radiologic Operative Units (ROU) because population health needs increase while healthcare systems provide less resources expendable in technologies and employee. Purpose: Create a Key Performance Indicator (KPI) defined Radiologic Team Performance Index (RTPI) able to compare the activity and efficiency of ROU operating under different environments and with different resources. Methodology/Approach: A survey was conducted in Sicilian Public Healthcare System on behalf of Sicilian Group of Italian Society of Medical Radiology (SIRM) for a total of 63 investigated ROU. Obtained informations concern workforce, emergency care organization, technologies available and radiologic examination volumes. Results: Investigated ROU demonstrated that, according to best practices, while professionals were correctly performing their institutional due activity, available technologies were generally used for less of 50% of thier operative capacity, pointing to a big issue due to the mismatch between machines and professionals using them. Lastly RTPI was calculated with a mean result, per district, of at least nine points. Conclusion: The RTPI demonstrates its usefulness in ROU activity evaluation facilitating facilitate comparisons between them. Practice Implications: Regional Healthcare decision-makers should take into account obtained information during territorial radiology network planning and resources allocation.

Hamartoma of the spleen (splenoma) with calcifications in a child with beta-thalassemia: A case report

Splenic hamartoma (or splenoma) is a rare, benign, vascular tumor, often incidentally found at imaging, surgery or autopsy. Albeit usually asymptomatic and rare in children, when it occurs in the pediatric population it is more commonly symptomatic. We report a case of a 15-year-old girl with iron-deficiency anemia and beta-thalassemia, who had a large (10 × 8 × 7 cm) splenic lesion with calcifications, incidentally found during follow-up for splenomegaly and histologically characterized as hamartoma with calcified areas. The association of hamartoma and hematological disorders is a very unusual condition in children.

Traumatic gastric rupture following blunt abdominal trauma: a case report about an atypical modality of presentation

Gastric rupture following blunt abdominal trauma is a rare presentation with a reported incidence of 0.02-1.7% in current literature. Traumatic gastric rupture is usually associated with other visceral injuries, such as splenic lesions and fractures. Prompt diagnosis and early intervention reduce mortality and morbidity. History of a recent meal has been implicated in traumatic gastric rupture. We report a case of blunt abdominal trauma with an isolated gastric rupture after a motor vehicle accident, managed successfully without any post-operative morbidity and mortality.

Mitomycin-based hepatic arterial infusion chemotherapy for solitary ampullary cancer liver metastasis: an unusual treatment for an uncommon disease

Ampullary carcinoma is an uncommon gastrointestinal disease. Its natural history is often characterized by the occurrence of liver metastases. Among patients who undergo pancreatoduodenectomy, those presenting with lymph nodes involvement are more prone to early distant disease relapse. In this report, a patient previously diagnosed with ampullary carcinoma had been treated with curative surgery. After subsequent adjuvant gemcitabine, the patient developed significant myelotoxicity and suffered from a single liver metastasis a few months later. A hepatic intra-arterial mitomycin plus fluorouracil-based chemotherapy was administered in order to avoid any serious systemic toxicity. The treatment was well tolerated and no serious side effects occurred. Extra-hepatic cancer relapse, involving intra-thoracic and abdominal lymph nodes, was observed not long after the initial intra-hepatic almost complete response. In conclusion, the locoregional chemotherapy administration was effective in overcoming any systemic toxicities and showed activity against the liver metastasis but it did not prevent extra-hepatic cancer dissemination.